Effects of two immunosuppression regimens on T-lymphocyte subsets in elderly kidney transplant recipients.
Freitas, G. R. R., et al.Frontiers in Immunology 2024; 15: 1405855.
Aims
This substudy of the nEverOld randomised controlled trial aimed to investigate how rabbit antithymocyte globulin (rATG) and mammalian target of rapamycin (mTOR) inhibitors affects the population of T-lymphocyte in elderly kidney transplant patients.
Interventions
Elderly recipients in the original trial were randomised to either either EVL conversion or standard immunosuppression.
Participants
55 kidney transplant recipients.
Outcomes
The main outcomes were quantification of total lymphocyte and T subsets.
Follow-up
365 days
CET Conclusions
The manuscript reports a sub-analysis of patients included in the nEverOld study. This was a single centre RCT comparing low-dose rATG and early conversion to everolimus to standard tacrolimus and mycophenolate sodium-based immunosuppression. The study shows that elderly (age > 60) recipients demonstrated lower pre-transplant and larger decreases in lymphocyte counts with rATG post-transplant, predominantly in memory T-cell subsets. Recovery of regulatory T-cell populations was better in elderly recipients and was unaffected by choice of maintenance immunosuppression. These data provide a useful insight into the immunological responses seen in elderly transplant recipients with different immunosuppressive regimens. They suggest that lymphocyte depleting agents should be used sparingly or with caution in this population and pave the way for future clinical trials of personalised immunosuppression for this increasing cohort of kidney transplant recipients.
Trial registration
ClinicalTrials.gov - NTC01631058